Provider Demographics
NPI:1851632442
Name:TERRELL, DAVID V (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:V
Last Name:TERRELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 PLANTATION BLVD.
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-1043
Mailing Address - Country:US
Mailing Address - Phone:573-471-0800
Mailing Address - Fax:573-471-5740
Practice Address - Street 1:760 PLANTATION BLVD.
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-1043
Practice Address - Country:US
Practice Address - Phone:573-471-0800
Practice Address - Fax:573-471-5740
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110033691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical